Provider Demographics
NPI:1811551658
Name:TRAN, KHANG QUOC
Entity Type:Individual
Prefix:
First Name:KHANG
Middle Name:QUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 MIRAMONTE AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3718
Mailing Address - Country:US
Mailing Address - Phone:650-930-9550
Mailing Address - Fax:
Practice Address - Street 1:1704 MIRAMONTE AVE STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3718
Practice Address - Country:US
Practice Address - Phone:650-930-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant